Cataracts are the second leading cause of blindness in the United States. Tom minimize the visual and functional impairment caused by cataracts, more than one million cataract extractions are performed on Medicare beneficiaries annually, making cataract extraction the most common surgical procedure performed on Medicare beneficiaries. The annual cost associated with treatment of cataracts is $2.5 billion. Geographic variation in the rate of cataract surgery is documented. This variation, plus variation in the pre-, intra- and post-operative management of cataract patients, likely has important clinical, economic and policy implications. We will form a multi-disciplinary team that will: (1) document variation in clinical outcomes patient functioning, patient satisfaction and health care costs as a function of alternative strategies for management of cataract; (2) determine the values placed on specific outcomes by patients and ophthalmologists; (3) define "appropriate" or "optimal" management strategies for different categories of cataract patients; and (4) develop a strategy for informing physicians and patients about the "optimal" management strategies, as well as a plan for evaluating the impact of the intervention. Four major data sources will be used to achieve these specific aims: (1) a literature review, including meta-analysis; (2) merged Medicare Parts A and B claims data; (3) a national survey of ophthalmologists and surveys of patients and ophthalmologists in four geographic areas; and (4) expert opinion. These data will be incorporated into a formal decision analysis to define "optimal" management strategies for patients with cataract and to project the clinical and economic impacts of alternative strategies for management of cataracts based on anticipated changes in demographic characteristics of the population over the next 25 years. A feedback intervention and an evaluation of it also will be planned as part of this project.